Download Infectious Disease in the Workplace “People at Risk”

Infectious Disease in the Workplace
“People at Risk”
Sept 2008
Enterprise Risk Management
Copyright 2008 – Aon Corporation
Table of Contents
1. Executive Summary ............................................................................................... 2
2. Awareness of the Infectious Disease Threat......................................................... 3
3. People at Risk Put Your Business at Risk............................................................. 4
4. Contagious Disease Captures the Headlines ...................................................... 5
5. Identifying What Is at Risk ...................................................................................... 7
6. Preparing for an Infectious Disease Crisis ............................................................ 8
7. Risk Management Strategies ................................................................................ 9
8. The Threat Is Not Over .......................................................................................... 11
9. Next Steps .............................................................................................................. 11
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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Executive Summary
Consider the numerous times you have come to work while sick. You are feeling
under the weather, but you have so much work to do, phone calls to return, deadlines
to meet, so the show must go on. Rarely does the notion of spreading germs cross
your mind. Unfortunately, this scenario is all too common and is one of the reasons
infectious diseases spread so rapidly in the workplace.
As an example, between August 18 and December 25, 1987, 116 employees at the
three futures exchanges in Chicago developed clinically diagnosed mumps. Three
cases subsequently occurred in household contacts of affected exchange employees.
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Twenty-one persons developed complications; nine were hospitalized. The direct
medical costs were over $56,000, with the total work loss probably in excess of 700
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days. The potential tort liability was significant: the mumps virus induced premature
labor in a pregnant employee. Fortunately, the labor was arrested, preventing a
premature birth with the attendant liability for possible brain injury to the infant. The
report of this epidemic does not discuss whether any of the infected men were
rendered sterile.
Keeping crisis management and business continuity plans up to date and thorough is
critical if you are to effectively protect your employees, customers, supply chain
contacts, stakeholders, and business assets during an outbreak of an infectious
disease. The threat posed to businesses by infectious disease is not new. However,
modern travel, migration, demographic changes, commerce and even medical
procedures (overuse of antibiotics causing microbial resistance) have greatly changed
the dynamic of infectious disease outbreaks.
Within this white paper we discuss how disease in the workplace can cause high
incidences of absenteeism, stress, productivity loss among employees, and a variety
of economic consequences. Preventative risk management, recovery strategies, and
planning steps will also be discussed.
1
Mumps in the workplace – Chicago. MMWR 1988 Sep 9; 37(35):533-38
2
Available at http://biotech.law.lsu.edu/Books/lbb/x618.htm
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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Awareness of the Infectious Disease Threat
3
On December 13, 2007, 30-year-old Sarah Smith arrived in Chicago on an American
Airlines flight from New Delhi, India. Sarah grabbed a quick dinner at an airport
restaurant as she traveled from O’Hare’s international terminal where she boarded
a flight to San Francisco. About a week after the flight, Sarah went to the Stanford
University Medical Center emergency department with a fever, chest pains and
coughing up blood. She was diagnosed with the full-blown version of XDR-TB the
abbreviation for extensively drug resistant tuberculosis, a rare form of TB that is highly
contagious and difficult to treat. Sarah had learned in India that she was sick with TB
but boarded the international flight anyway because she wanted to be treated at her
local hospital in San Francisco.
Sarah has since been released from the hospital after months in isolation, but will
remain quarantined at home for several more weeks, local health officials said. “We
don't really want anyone right now to come into contact with her,” said Dr. Marty
Fenstersheib, health officer for Santa Clara County. The woman continues to take
antibiotics, and a health care worker directly observes her taking her medication every
day, a standard protocol for TB, Dr. Fenstersheib said. “She may have to take drugs
for up to two more years to completely eradicate the disease,” he added.
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This true story was reported by several news sources, including Fox News , but it
doesn’t stop there. The Center for Disease Control (CDC) identified 44 people from
16 states who were within two rows of Sarah on her flight. The CDC sent health
officials in the 16 states a list of the names and asked for help in having them tested
for TB. So far, they have uncovered a second case of TB after testing more than two
dozen passengers, but no one knows about the people she interacted with between
flights or after she landed in San Francisco. That’s part of the risk of infectious
diseases – whether it’s TB, influenza or other debilitating diseases: people who are
capable of spreading a highly contagious disease can travel the world within a matter
of hours and disappear into the crowd. When people are at risk, the ability to continue
business operations is also threatened. What would you do if Sarah was an employee
of your organization and came to work, putting your workforce at risk? What would you
do if one to two thirds of your employees did not show up to work for several weeks
or months?
3
An “alias” is used to protect the patient’s identity
4
Available at http://www.foxnews.com/story/0,2933,351656,00.html
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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People at Risk Put Your Business at Risk
Today’s highly mobile, interdependent and interconnected world provides myriad
opportunities for the rapid spread of infectious diseases, which is why it is so critical
to update and expand your organization’s crisis management and business continuity
plans to protect your employees, customers, supply chain contacts, stakeholders, and
business assets. As illustrated by Sarah’s story, infectious diseases spread faster
across the globe today than at any other time in history. Estimates show that over
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2 billion airline passengers travel each year . An outbreak in any one part of the world
is only a few hours away from emerging somewhere else.
Infectious diseases are not only spreading faster, they appear to be emerging more
quickly than ever before. Since the 1970s, emerging diseases have been identified at
a rate of one or more per year. During this same time period, the World Health
Organization (WHO) has verified more than 1,100 epidemic events worldwide. The
spread of infectious disease is not just a public concern, but also a business risk.
Disease in the community will inevitably affect the workplace. If an organization has
an inadequate communicable-illness policy and response plan, the repercussions from
the spread of an infectious disease in the workforce could produce high incidences of
absenteeism, stress and productivity loss among workers and further lead to economic
consequences affecting business continuity and even liability.
The workplace is an incubator for diseases. Close quarters, exposure to poor personal
health habits (failure to wash hands and inadequate practices to reduce spread of
disease through coughing and sneezing), and the rapid spread of disease through
international travel all lead to the increased likelihood of disease being introduced into
the work environment. This is especially true in organizations that may have
inadequate environmental/engineering controls or tolerate employees reporting to
work when they are sick. In these environments, the rapid spread of disease, prompted
by the speed and ease of international travel, increase the likelihood of the rapid
introduction and spread of an infectious and debilitating disease. Traditional business
continuity planning has consistently focused on preparing an organizational response
to an infrastructure disaster. However, after an infectious disease outbreak, the
infrastructure remains intact, but fewer people are available to run the equipment,
manage the services and produce revenue. Most business continuity plans may not
address the steps needed to mitigate the spread of an infectious disease within a
workforce or the redeployment of people and skill sets required to adequately respond
to an infectious disease crisis.
5
2007 World Health Report: Available at http://www.who.int/whr/2007/overview/en/print.html
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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Contagious Disease Captures the Headlines
Several exotic diseases, including Severe Acute Respiratory Syndrome (SARS),
Norwalk-like viruses (NLV), Community-Acquired Methicillin-Resistant Staphylococcus
aureus (CA-MRSA), Legionnaires’ disease and others, capture the imagination as
they grab headlines. The media stories and spread of these diseases can cause
widespread fear and panic, causing people to stay at home to avoid infection. Such
absenteeism may increase if other events, such as school closures or failures in public
transportation further inhibit employees’ ability to report to work. In addition to affecting
personnel availability, the anxiety created by the emergence of a novel infection may
also deter consumers from normal purchasing patterns and impede the supply chain
from supporting business.
The re-emergence of several garden-variety infectious diseases such as measles and
tuberculosis (TB) may cause an even greater impact on business than the more exotic
conditions mentioned above. While TB remains a substantial health concern around
the world, the prevalence of TB in the US has been dramatically reduced over the
years. In fact, many have thought it would be eradicated just as smallpox has been.
“However, the emergence of drug resistance in many organisms is reversing some
of the therapeutic miracles of the last 50 years and underscores the importance of
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disease prevention” . Given that society is familiar with these conditions, they provoke
less anxiety and people may not take appropriate precautions to avoid contracting and
spreading disease. For example, in 2006, a measles outbreak occurred in Boston
Massachusetts and over 1,000 employees of a financial institution were impacted. The
infection at the Massachusetts firm was traced to an unvaccinated contract employee
from Asia. By order of the Department of Health, the firm required employees who
could have come in contact with an infected individual and who could not produce
documentation of vaccination or serologic proof of immunity to be excluded from work
for 21 days unless vaccinated within 72 hrs. In addition, the firm had to provide
surveillance for 42 days after the last rash outbreak. The organization had to mobilize
employees to be able to work from home, distribute the measles, mumps and rubella
(MMR) vaccine, and make regular reports to the health department. In the end, 31
communities were impacted and 12,000 doses of vaccine distributed at a cost of
$250,000. This figure does not contemplate the substantial cost to the business due to
lost productivity, increased cost of benefits, etc. With the advent of the MMR vaccine,
measles has been virtually eliminated in the United States. However, in other parts of
the world, people may not have access to the MMR vaccination.
As an example of the financial impact disease can have on a business, research
shows it costs an organization an average of $392 each day an employee is out with
flu-related illness, and typically at least 15 percent of employees are out of the office
each year due to the flu alone. Also, the typical flu keeps an employee out of the office
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for an average of six days .
6
MMWR July 30, 1999 /48(29);621-629, Achievements in Public Health, 1900-1999: Control of
Infectious Diseases
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Available at http://findarticles.com/p/articles/mi_m0EIN/is_2008_July_2/ai_n27878714
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Another example of rapid disease spread is the recently discussed connection between
an infected healthcare worker (HCW) and the transmission of Bordetella pertussis
(B. Pertussis – whooping cough) to newborns in a Texas hospital nursery in 2004. The
healthcare worker, a nurse, had previously been fully vaccinated against B. pertussis
during early childhood but her immunity had waned. During the time she was working
symptomatically, she cared for 113 infants, 11 of whom subsequently had a diagnosis
of pertussis, an attack rate of 9.7%. The county health department directed the hospital
to contact the families of all infants who had been in its newborn nursery during the
period of time in question (May 31 – July 17, 2004) so that the infants could be
screened for respiratory symptoms and administered antibiotics as needed. The
families of 158 infants who had been in the newborn nursery during that time were
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contacted; a total of 110 infants returned to the hospital for testing . Although this case
was hospital-based, it offers a challenge to any business. How will the business
respond to a sick employee who wants to continue working or is asked to continue
working? This question should be addressed in the company’s employee health and
communicable disease policies and relayed during company orientation.
8
MMWR Weekly June 6, 2008/57(22);600-603 Hospital-Acquired Pertussis Among Newborns –
Texas, 2004
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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Identifying What Is at Risk
An infectious disease outbreak produces a different set of challenges for serviceoriented businesses compared to manufacturers. Organizations need to be aware
and prepared for these events. Service providers have a higher degree of consumer
interaction and thus may be more likely to spread infection exponentially, whereas
supply chain issues may be more of a concern for manufacturing firms. Of course,
supply chain disruption can impact service providers as well due to the manufacturers’
inability to produce, package and/or deliver the goods as promised. In the event of a
disease outbreak, both business types could potentially lose key, trained personnel
and potential customers to illness.
Additionally, communicable illnesses in the general population can result in various
economic issues for businesses. These can include changes in demand for business
services, challenges to reputation, human resource challenges, and legal issues. As
an example, in 2003 the most severe economic impact from SARS occurred in the
travel and tourism industry, with airlines being particularly hard hit. Decline in regional
airline traffic reached 40-50%. During its four month run in Toronto, SARS killed fewer
than 50 people, yet travel to and from Toronto plummeted overnight and ultimately cost
the city’s hotel industry more than CAN$125 million. More than 15 thousand people
were quarantined in their homes for ten days and many businesses (including banks)
had to designate essential employees to telecommute. In the end, SARS is estimated
to have reduced Canada’s GDP by 0.6%.
In another example of economic impact to business, a well-known healthcare firm
recently cited impacts from the recent year’s severe flu season as a main driver in
their first quarter 2008 $0.02 Earnings per Share decline. Furthermore, the Centers
for Medicare and Medicaid Services (CMS) the largest single payer of health benefits,
recently announced a revision to the Inpatient Prospective Payment System (IPPS),
the primary government reimbursement mechanism for most short term acute care
hospitals. These changes, effective FY 2009 (commencing October 1, 2008), support
CMS’s value-based purchasing strategy (VBP) to pay providers for performance
based on quality and not to reimburse the hospital for treatment associated with
preventable hospital-acquired conditions (HAC) — including several infectious
diseases. Commercial insurers are following suit. Health Partners in Minneapolis was
one of the first insurers not to reimburse for what is considered preventable medical
error. This list is expected to expand significantly, and although the financial impact
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of the change is not yet known, it is predicted to be significant .
The economic consequences of an infectious disease breakout could also include
increased litigation. In the United States employees are protected under the
Occupational Safety and Health Act (OSHA), and the Health Insurance Portability and
Accountability Act (HIPA). If a business does not take the proper precautions, there is
potential for various lawsuits, including: workers compensation, breach of privacy,
discrimination, unfair labor practice, and negligence.
9
The Regulatory Impact Analysis for hospital-acquired conditions as reported in the Final Rule estimates
saving (to CMS) for the next five fiscal years starting in FY 2009 to be $20 million per year. Federal register
Vol. 72, No. 162/Wednesday, August 22, 2007/Rules and Regulations pp 48168
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Preparing for an Infectious Disease Crisis
According to the CDC, each year in the United States 5% to 20% of the population gets
the flu on average. More than 200,000 people are hospitalized from flu complications
10
and about 36,000 people die from flu . Many companies take no precautions to
reduce the incidents and the attendant costs, mistakenly taking a “business- as-usual”
approach. When they’re impacted by illness, these firms are often inadequately
prepared to provide timely and accurate information to their employees and customers.
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They typically have not established a process to interact with public health agencies.
During an infectious-disease outbreak, these employers are likely to take the same
wait-and-see response until it becomes too late. A better response is to develop plans
and relationships with the local public health department and medical community to
collect and monitor information as it becomes available. This enables employers to
have access to critical information as it becomes available from local health authorities,
the CDC and healthcare professionals. It avoids reliance on media reports and
diminishes the uncertainties that occur immediately after a widespread disaster. The
organization should also use this information in educating its employees and customers
in how to respond to the health crisis. To do so effectively requires establishing a
process for quickly contacting employees and customers at the time of the outbreak.
The goal of this preparation is to improve customer and employee safety while
diminishing the economic impact on the business of an infectious-disease crisis.
Preparation would also help an organization to assess current HR policies relating
to absenteeism, payroll, healthcare and disability and make policy and program
decisions relative to an infectious-disease outbreak before an incident occurs. These
proactive steps will significantly reduce confusion, avoid hasty decisions regarding
employee policies, support employee relations and strengthen customer confidence
in the organization during an outbreak of an infectious disease.
10
Available at www.cdc.gov [site accessed June 24, 2008]
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The CDC has prepared a Business Pandemic Influenza Planning Checklist which can be used
as a guide for other contagious diseases as well. Available at
http://www.pandemicflu.gov/plan/pdf/businesschecklist.pdf
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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Risk Management Strategies
Without a business continuity plan that addresses the recognition, prevention, and
mitigation of communicable diseases, employers will be unprepared to effectively
and efficiently deal with significant absences, adjustments to benefit plans and other
challenges that arise due to the spread of an infectious disease.
The repercussions of inaction during a disease outbreak are numerous; however, the
risks can be hedged by having robust crisis management and business continuity plans
in place. Such plans should consider:
•
The role of government (local, state, national) during an outbreak
•
The role of public health to:
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1. Provide vaccinations and forms
2. Provide support for clinics
3. Contact Tracing
4. Laboratory Testing
5. Control Guidelines
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Note: A document released on June 3, 2008 and available at [www.pandemicflu.gov] proposes guidance
for businesses on antiviral stockpiling as part of an organization’s planning process for pandemic influenza.
The guidelines state: “Private stockpiles, in coordination with public health stockpiles, would extend
protection more broadly than could be achieved through the public sector alone and improve the ability to
achieve the national pandemic response goals of mitigating disease, suffering, and death, and minimizing
impacts on the economy and functioning of society.”
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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•
The role of Employer to:
1. Review and test your business continuity plan with particular emphasis on
alternate suppliers or third party services at least annually
2. Update and exercise your communications plans for all stakeholders (i.e.
employees, customers, financial interests etc.) as needed
3. Establish or reconfirm contact protocols to local, state and federal public health
and public safety agencies. Understand their impact on your operations.
Assure that the lines of communication are open and information is flowing
4. Understand and adjust, if possible, business contracts, including insurance
policies, if you are unable to perform your duties (e.g. how do forced
cancellations in your contracts impact your relationship with customers and
suppliers.)
5. Evaluate your information services capabilities especially availability of working
from home
6. Develop and test a medical or wellness plan that includes vaccinations,
antiviral medicines, exposure reduction/avoidance and education of employees
7. Become knowledgeable of the legal ramifications if your organization is
considered a ‘critical infrastructure’ and you have ‘special responsibilities that
you can no longer perform’
In order to be prepared prior to an outbreak, it is important to explore these steps,
stockpile any needed equipment and supplies and document the economic impact and
recovery procedures.
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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The Threat Is Not Over
Pandemic flu is an infectious disease that continues to be a threat, even if it’s not
making as many headlines as it used to. If you have already developed pandemic
plans, these prevention strategies might be familiar to you. Reviewing these plans
as to their applicability and responsiveness with new scenarios such as a measles
outbreak will be beneficial. For example, the measles outbreak at the financial
institution in Boston, Massachusetts, meant that their office space was not accessible
and IT equipment needed to be procured and distributed to employee’s offsite so that
operations could continue. This needed to be accomplished quickly and efficiently while
tracking new usernames and passwords for this “extra” equipment. While the financial
institution’s continuity plans had outlined strategies for IT protocols in the event of a
disaster, policies needed to be revised to address this new and unanticipated situation:
existing infrastructure was in place, however, personnel could only access it remotely.
Next Steps
Planning and preparing these prevention steps now, before an incident occurs, could
mean the difference to continuing your business or shutting it down. Your primary goal
is to keep workers safe, minimize exposure and put a plan in place to preserve your
workforce and the skill sets necessary to keep your business in operation. A secondary
goal is to plan your recovery to full operations as soon as possible.
Risk managers need to partner with their Human Resources counterpart and work with
corporate communications to:
1. Create business continuity and crisis plans to address the people side of business
continuity following an infectious disease outbreak
2. Establish a rapid response process for identifying who takes charge at your
locations to oversee the crisis management plan as well as how employees
are contacted
3. Identify the skill sets needed to maintain operations at a minimum level
4. Work with your supply chain to identify their strategy for continuing operations
during a disease outbreak
5. Review your contracts and determine if adjustments are needed to address your
commitments during a disease outbreak
6. Create a framework for your media, shareholder and customer communications
It cannot be over-emphasized that a truly effective business preparedness and
response coordination mechanism cannot be managed in a vacuum. Cooperation,
collaboration and investment are necessary to ensure a safe environment for your
employees, customers, and clients, while continuing business operations in the event
of an infectious disease outbreak. Understanding the role of the employer, government,
and public health authorities are vital components in the process. Even with good
prevention methods, your business may still be exposed to an infectious disease
outbreak. However, with well thought-out and tested crisis management and
business continuity plans, the impact of an outbreak on your business may be
significantly reduced.
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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For additional guidance on people at risk crisis planning, contact:
Mike Giacobbe
Director, Enterprise Risk Management
Aon Global Risk Consulting, Americas | +1 312-381-4185
[email protected]
Authors:
Carey Loukides
Consultant, Business Continuity Management
Aon Global Risk Consulting, Americas | +1 603-424-3769
[email protected]
Jessica Page
Consultant, Enterprise Risk Management
Aon Global Risk Consulting, Americas | +1 312-381-2063
[email protected]
Anthony Madera
Senior Consultant, Business Continuity Management
Aon Global Risk Consulting, Americas | +1 978-463-3413
[email protected]
Kenneth F. Groh
Vice President, Human Capital
Aon Consulting, Americas | +1 312-381-4813
[email protected]
Roberta Carroll
Senior Vice President, Healthcare Risk Management Consulting
Aon Healthcare, Americas | +1 813-926-8069
[email protected]
Gisele Norris
National Director, New Product Development and Alternative Risk Transfer
Aon Healthcare, Americas | +1 415-458-2973
[email protected]
Aon White paper: Infectious Disease in the Workplace, “People at Risk”
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